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KC TRAINS SPEAKERS B |
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Speaker’s Bureau |
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Kansas City Metropolitan Library & Information Network 15624 E. US Highway 24 Independence, MO 64050 Phone: (816) 521-7257 Fax: (816) 461-0966 sburton@kcmlin.org
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Application |
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You may photocopy this form as needed, then fax or mail one copy to the KC Trains Speaker’s Bureau Coordinator at the address below. Please fill out all portions of this form.
Speaker: _____________________________________________________________________
Program: ____________________________________________________________________
Request the following Day, Date and Time for Program (please select two)
   First Choice _______________________________________________________________
   Second Choice _____________________________________________________________ Purpose of Program: ____Staff Day _____Dept. Meeting _____ Keynote _____ Staff Training
Program Location and Address: __________________________________________________
Sponsoring Organization: _______________________________________________________
Address: _____________________________________________________________________
City, State, Zip: _______________________________________________________________
Program Coordinator: __________________________________________________________
E-Mail: _____________________________________________________________________
Work Phone: _______________ Cell Phone: ______________ Home Phone: _____________
We will contact you on the availability of this speaker and costs for the presentation.
Estimated Attendance: _________________________________________________________
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